Facilities can post open shifts that result from job vacancies, sickness, vacations, or even an increase in minimum staffing requirements and nurses can choose the shifts that work best for them, in their desired location. As part of the staffing study, quantitative analyses will be conducted to identify staffing levels associated with improved quality of care and resident safety in nursing homes. It means that you have to confront issues around wages, issues around benefits, issues around working conditions and what it means to have a safe working environment for the caregivers.. The vast majority of those comments voiced concerns related to residents not receiving adequate care due to chronic understaffing in facilities. Contact us now for staffing assistance. 1 DON RN full-time or minimum 36 hrs/wk (at least 18 hrs between 7am and 7pm). "What has been so ambiguous and subjective is how 'sufficient' is interpreted.". In Takoma Park, Maurice Miller doesn't blame the staff who have left his facility in recent weeks for other jobs. An official website of the United States government. could also make it difficult for facilities to find and retain high-quality nursing staff, which would reduce the number of residents that facility could support. But he is appealing to younger people to consider a job in a nursing home. Specifically, Florida retained its total hprd but increased the number of licensed practical nurse hours and decreased the number of certified nursing assistant hours that count toward the overall total. Importantly, this study is on an accelerated timeline and seeks to build on, not replace, previous studies. 5 states with the highest-rated nursing homes. Qualitative analysis will include primary data collected during site visits, including interviews, surveys, and observation data in nursing homes. [6]What else is included in the study? Maurice Miller lies in bed in his room at a nursing home in Takoma Park, Md., on Thursday. What did CMS learn from the Request for Information? Missouri waived its training requirements, and Iowa temporarily suspended an additional on-the-job training requirement for CNAs. Create customized staffing solutions that fit your unique needs, which we know can change at any time. Thats according to a report compiled by professional services firm CliftonLarsonAllen (CLA) as part of a partnership with the NYS Health Facilities Association. Nursing home resident advocacy groups and family members of residents were generally strongly supportive of establishing a minimum staffing requirement, while other industry and provider groups expressed significant concern. Skilled Nursing News is part of the Aging Media Network. These states include Oregon and South Carolina. [4] Additionally, regulations specify that nursing homes are required to conduct an annual facility assessment, which considers resident needs and staff ability to provide care. WebThe Manager of an ALR must: Be at least 21 years old Have experience in administration, supervision, and management Have a Bachelor's degree or equivalent experience in human services management, housing management, or nursing home management The Manager must be of good moral character and must never have been convicted of a felony. In the midst of these continuing financial and staffing pressures, providers would be remiss if they did not also consider the existing and prospective regulatory requirements for minimum staffing levels. The feedback received has and will be used to inform the research study design and proposals for minimum direct care staffing requirements in nursing homes in 2023 rulemaking. CMS appreciates the interest shown by so many stakeholders to date during the RFI process and looks forward to further engagement on this issue. 0000001884 00000 n Other states may have adopted or proposed Medicaid provider reimbursement rate changes that do not explicitly require corresponding increases in direct care staff wages. The mandate comes at a time when the Biden administration has set its sights on a federal nursing home staffing minimum. Massachusetts and North Carolina both direct nursing homes to devote a certain share of the rate increase to direct care staff wages (75% and 80%, respectively). As of December 2021, only the District of Columbia met or exceeded the minimum of 4.1 hprd recommended to prevent harm to residents. "1ARPeBJU& lL" L@7, H XY~ B 0000035945 00000 n Connecticut and Kansas adopted changes that allow temporary nurse aides to work, though Connecticuts temporary executive order has expired. What did CMS learn from the Request for Information? Of the 3.5 hours, no less than 2.2 hours of care must Helen Schaub, the unions policy and legislative director, said during the virtual news conference that the health department will view payroll based journal (PBJ) data to ensure nursing homes are complying with the laws. Launched in August 2022 and expected to continue through the winter, the staffing study is comprised of four main parts: literature review, site visits, quantitative analyses, and cost analyses all further described below. 1 DON RN full-time. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet Awarded Best of Staffing - Talent 2022 and rated as a Top Workplace 2022 by the Orlando Sentinel, Jackson Nurse Professionals connects today's travel nurse to It also states that nursing home operators in the state are required to return all profits in excess of 5% to the state, regardless of the quality of care or whether the operator sustained losses in prior years. You can be a dog walker for $18 an hour," she says. As a result, nursing homes have been able to determine what sufficient nursing staff means on their own, which has led to wide variations in nursing home staffing across the countryand as a result, wide variations in the level of care and safety of residents. %PDF-1.7 % Nursing Home Staffing Study Stakeholder Listening Session-August 29, 2022. To maintain the highest practicable physical, mental, and psychological well-being of each resident. Additionally, a series of Institute of Medicine reports have recommended that nursing home staff include registered nurses 24 hours a day. 1 Assistant DON RN full-time, minimum 36 hours, 4 days/week. 2 Department of Nursing & Patient Care Services, VA San Diego Healthcare System, San Diego, CA, USA. Federal law authorizes the Health and Human Services (HHS) Secretary to establish requirements relating to nursing home residents health, safety and well-being as conditions for facilities to receive payment from the Medicare and Medicaid programs. While staffing shortages in nursing homes have existed for decades, the COVID-19 pandemic has highlighted and intensified the need for sufficient, consistent, trained staff to care for residents. Published: May 16, 2022. This issue brief summarizes federal and state standards related to nursing home staffing prior to COVID-19 and builds on existing information by identifying changes to state minimum staffing requirements adopted since the onset of the COVID-19 pandemic. While there are a variety of opinions among stakeholders on establishing minimum staffing requirements, it is CMS goal to consider all perspectives, as well as findings from the staffing study, as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. CMS will be conducting a mixed methods study with qualitative and quantitative elements to inform the minimum staffing proposal. 1 Assistant DON RN/LPN full-time. 3 Department of Physiological Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, 0000002362 00000 n 1 RN Day & Evening; 1 RN/LPN Night. The law was first introduced by former Gov. Additionally, some commenters noted that evidence shows that most facilities have adequate resources to increase their staffing levels without additional Medicaid resources. Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in San Francisco, California. At least three states (MI, NC, OH) adopted temporary increases or one-time bonuses to nursing home staff wages post-COVID. hide caption. In eight states, at least half of nursing facilities reported one or more staff shortage as of March 20, 2022. levels. Eric Lee for NPR 0000004153 00000 n 7500 Security Boulevard, Baltimore, MD 21244, By:Pauline Karikari-Martin PhD, MPH, MSN, PHNA-BC, RN Senior Nurse Researcher and Cameron Ingram, MFA Policy Analyst of the Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services Staffing Study to Inform Minimum Staffing Requirements for Nursing Homes, In February 2022, President Biden announced a, The Centers for Medicare & Medicaid Services (CMS) has launched a multi-faceted approach aimed at determining the minimum level and type of staffing needed to enable safe and quality care in nursing homes. 0000055058 00000 n All rights reserved. On some days, she has as many as 13 residents to care for on a shift. 2.5 hprd by CNA, not below 1:20 CNA to resident ratio. Skilled Nursing News is the leading source for news and information covering the skilled nursing industry. In conducting the cost-benefit analysis required for any rulemaking, including the staffing requirement, CMS must evaluate any associated incremental costs that facilities would likely face. The Centers for Medicare and Medicaid Services (CMS) announced in November 2021 increased oversight of nursing services pursuant to 42 CFR 483.35, which mandates sufficient nursing staff at facilities receiving Medicare reimbursement: The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facilitys resident population in accordance with the facility assessment required at 483.70(e).[5], Specifically, CMS will survey nursing homes in the future for nurse competency, inappropriate use of antipsychotic medications, and other areas of residents health and concern. Washington Offices and Barbara Jordan Conference Center: 1330 G Street, NW, Washington, DC 20005 | Phone 202-347-5270, www.kff.org | Email Alerts: kff.org/email | facebook.com/KaiserFamilyFoundation | twitter.com/kff. Others recommended that minimum staffing levels be established for residents with the lowest care needs, assessed using the MDS 3.0 assessment forms, citing concerns that acuity-based minimums will be more susceptible to gaming. WebNew Appraisal Review Requirements and Instructions Regarding Department of Veterans Affairs Appraisal Management Service for the Lender Appraisal Processing Program and Among the states that adopted increases, the amount ranged from an additional 0.16 hprd in Connecticut to an additional 3.78 hprd in Rhode Island. Or when he misses his wheelchair time because there aren't enough staff to lift him out of bed. Fines for noncompliance could be up to $2,000 a day, she said. It's also a bad day when he cannot call his 94-year-old mother, because his computer has been pushed out of reach. The new federal staffing requirements would likely increase costs for nursing homes, which could lead to even more closures and cutbacksultimately making it even more difficult for seniors to get the care they need. A new law in New York state will require nursing homes to meet minimum standards for staffing and patient care. as it crafts future minimum staffing requirements that advance the publics interest of safe, quality care for residents. In determining what 24-hour services provide sufficient staffmeaning registered nurses (RNs), licensed practical and vocational nurses (LPNs and LVNs), and certified nurse aides (CNAs)facilities must account for individual resident assessments and plans of care, in addition to the facility assessment. The government has increased scrutiny and staffing requirements in response to COVID-19. Accordingly, using the information described above, https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9, https://www.federalregister.gov/documents/2022/04/15/2022-07906/medicare-program-prospective-payment-system-and-consolidated-billing-for-skilled-nursing-facilities, https://www.justice.gov/sites/default/files/elderjustice/legacy/2015/07/12/Appropriateness_of_Minimum_Nurse_Staffing_Ratios_in_Nursing_Homes.pdf, CMS Drug Spending Dashboards and the Inflation Reduction Act, Addressing Rural Health Inequities in Medicare, The Path Forward: Improving Data to Advance Health Equity Solutions. States can choose to adopt staffing or training requirements that are stricter than federal rules as part of their role in licensing nursing home providers and administering state Medicaid programs, which finance the majority of nursing home care. In some states, the minimum requirement is half the recommended level. Opens in a new window. 0000006058 00000 n found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. NurseDash is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. A decade after suffering a stroke that forever changed his life, Maurice Miller has good days and bad ones. Wages: At least four states (CO, IL, MA, NC) adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic. This equates to 0.30 staffing hours per resident day (hprd).3 Facilities also must designate a full-time registered nurse as a full-time director of nursing. Before sharing sensitive information, make sure youre on a federal government site. Emma Childress , and The pandemic has taken a substantial toll on people living and working in nursing homes. 0000007275 00000 n It is even more so now.". Four out of 5 who initially express interest in a job don't come in for interviews. 0000029962 00000 n Mitigating factors can be considered by the [d]epartment when assessing penalties for non-compliance at a later date., 1199SEIU United Healthcare Workers East, Centers for Medicare & Medicaid Services, CliftonLarsonAllen, CMS, New York State Health Facilities Association. Following up on the White House announcement of a package of nursing home reforms, CMS recently released a request for information to inform its planned development of a federal minimum staffing requirement for nursing homes. Numerous studies over several decades have found that high staffing levels are associated with higher care quality for nursing home residents. At least eight states adopted temporary changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes (Appendix Table 3). WebA skilled nursing facility is a special facility or part of a hospital that provides medically necessary professional services from nurses, physical and occupational therapists, speech pathologists and audiologists. Insufficient nursing home staffing levels are associated with negative outcomes for residents including increased rates of hospitalization, dehydration, weight loss, and pressure ulcers. "They look to you for comfort, but then when you don't have time to adequately give them the comfort they deserve, it's not fair," says Ward. To meet the new staffing requirements, it would take an additional 5,610 additional staff for New York facilities, according to the report. 0000031136 00000 n President Bidens proposed Build Back Better bill, for example, would require the U.S. Department of Health and Human Services (HHS) to submit reports to Congress on the appropriateness of minimum staff to resident ratios in skilled nursing facilities,[4] signaling future potential minimum staffing ratios that might extend beyond the reach of COVID-19. For nursing homes selected to participate in the site visit aspect of the study, CMS encourages active participation to ensure your perspectives are captured. For example, the U.S. Department of Justice and the Federal Trade Commission have recently increased enforcement against staffing agencies that price-fix nursing wages, as well as against nursing personnel agencies who engage in price gouging or unfair competition. Federal law currently requires Medicare and Medicaid-certified nursing homes to provide 24-hour licensed nursing services, which are sufficient to meet nursing needs of [their] residents and must use the services of a registered professional nurse at least 8 consecutive hours a day, seven days a week. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. 0000006448 00000 n Ease your staffing struggles with NurseDash! The Henry J. Kaiser Family Foundation Headquarters: 185 Berry St., Suite 2000, San Francisco, CA 94107 | Phone 650-854-9400 0000001178 00000 n document.write(new Date().getFullYear()); This effort includes issuing a Request for Information (which occurred earlier this year as a part of the Fiscal Year 2023 Skilled Nursing Facility Prospective Payment System Proposed Rule. Some commenters also stated that the following factors should be considered: Medicaid census, facility size, ownership status (profit or non-profit), amount of skilled nursing facility competition in the area, and, community poverty and Medicare census rates. We also are grateful for the dedicated work of Meghana Ammula, KFF research assistant. Strengthen staffing, testing and infection control measures at long-term care facilities; and Keep stakeholders informed about the impact of COVID-19 on long-term Numerous studies throughout the years have shown that the quality of care residents receive in a nursing home is directly related to the adequacy of the nursing homes staffing levels. The final regulations will be published by the end of December 2022 in the Pennsylvania Bulletin, Training: At least 3 states (KY, MO, WI) adopted permanent changes to staff training requirements post-COVID to expand the pool of staff available to work in nursing homes, while at least 8 states (AK, CT, DE, IA, IN, KS, MO, WI) adopted temporary changes in this area. Federal regulations require nursing aides to complete a 75-hour training program and to pass a competency evaluation in order to work in a nursing home longer than four months. Legislation that would have permanently increased minimum staffing requirements post-COVID was proposed but failed to pass in at least two states. [8], States have also recently increased scrutiny over minimum nurse staffing levels. 0000034862 00000 n The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 0000002105 00000 n How does new federal staffing requirements affect facilities? [1] Tim Regan, 81% of Assisted Living Providers Report Recent Staff Shortages, Senior Housing News (June 23, 2021), available at https://seniorhousingnews.com/2021/06/23/81-of-assisted-living-providers-report-recent-staff-shortages/. is an on-demand healthcare marketplace that connects nurses with nursing homes and other healthcare facilities. This staffing study seeks to help identify a minimum staffing level, which would include RN, LPNs/LVNs, and CNAs, that will establish a threshold below which residents would be at substantially increased risk of not receiving the safe and quality care they deserve. In an effort to improve these factors, the Centers for Medicare and Medicaid Services (CMS) is proposing, new nursing home minimum staffing requirements. 0000007304 00000 n Belle Harris North Carolinas legislature appropriated $1 million for one-time bonus payments to direct care staff, while Ohios legislature appropriated $300 million for wages, incentives, and bonuses to recruit and retain direct care staff. One of these states, Colorado, passed legislation that established a $15.00 per hour minimum wage for nursing home direct care staff as of January 2022. While we reviewed legislation and regulations in all 50 states and DC, this brief may not capture all relevant policy changes. MECHANICSBURG, Pa. (March 1, 2023) LeadingAge PA, an association representing more than 370 aging services providers, including many who operate Nationwide, nursing homes are down more than 240,000 employees since the start of the pandemic, according to the Labor Department. Of course, once CMS issues its proposal for minimum staffing requirements in Spring 2023, that proposal will go through the notice-and-comment rulemaking processproviding further opportunities for all interested parties to weigh in. Facilities will be held accountable if they fail to meet this standard. CMS also plans to conduct a research study, noting that resident acuity has increased in recent years, and to issue proposed regulations within one year. 0000002408 00000 n 0000002445 00000 n The only resolution to the workforce crisis, which is not going to be resolved today, tomorrow, in a month, or six months for that matter, is a partnership between the administration, the legislature, providers and labor working together to put in real initiatives that will help recruit and retain workers, Hanse told Skilled Nursing News. A December 2021 study found that although minimum staffing thresholds exist, the requirements are vague and not adequate for providing seniors with an acceptable level of care. 0000036022 00000 n Are there federal nursing home staffing standards currently in place? Flexible pay and scheduling structures for nursing staff, including incentive pay, career development and training programs, and alternative benefits that do not increase base pay. To attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident. 0000008084 00000 n That is the main factor they stress at the job, yet you don't give us the staff to provide that," Ward says. 0000012942 00000 n Add 1 Assistant DON RN full-time, 1 RN/LPN each shift, 1.0 RN/LPN hprd (24 hour average). This staffing study seeks to help identify a minimum staffing level, which would include RN, LPNs/LVNs, and CNAs, that will establish a threshold below which residents would be at substantially increased risk of not receiving the safe and quality care they deserve. Stories like Miller's and far worse have pushed the Biden administration to call for major reforms in nursing homes. What will the staffing study look like? At least two states (OR, SC) adopted temporary decreases to account for potential staffing issues during the pandemic. The public comment period closed on June 10, 2022, and CMS received over 3,000 comments from a variety of interested parties including advocacy groups; long-term care ombudsmen; industry associations (providers); labor unions and organizations; nursing home staff and administrators; industry experts and other researchers; family members, and caretakers of nursing home residents. A 2001 CMS study recommended a minimum of 4.1 nursing hours per resident per day to prevent harm to residents. More information and the registration link for the event is available here: https://abtevents.webex.com/abtevents/j.php?RGID=r8e7713354ab6b79a94b9e3dd4d265ce9. To inform future staffing requirements, the U.S. Department of Health and Human Services (HHS) should fund research on the minimum and optimum staffing levels for nurses, therapists, recreational However, there has never been a federally required minimum number of staffing hours per resident day, despite repeated calls to establish one from researchers and patient advocates over the last several decades. Lying in bed in his darkened room, Miller usually knows when there are fewer than five nursing assistants tending to the 50 or so residents on his hall. [6], Furthermore, CMS has increased its reporting requirements for nursing homes, public posting of facility staffing measures, and enforcement penalties for nursing homes that do not comply with staffing requirements. In response to the COVID-19 public health emergency, CMS temporarily waived the training requirement as a means of addressing potential staffing shortages during the pandemic. In Four of these states (AK, DE, IN, and WI) lowered the training hour requirements for CNAs during the pandemic, in efforts to address staffing issues. 1570 Grant Street. KFF appreciates the contributions of Emma Childress, law/master of health administration student at St. Louis University, and Belle Harris, law student at Georgetown University, who worked as contractors on this project. The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. (Nov. 22, 2021). Another commenter, whose parents live in a nursing home, noted that they visit their parents on a daily basis to ensure the provision of quality care and reported that staff in the facility have stated that they are overworked and understaffed. WebNURSING HOME STAFFING STANDARDS IN STATE STATUTES AND REGULATIONS UCSF Survey of Nursing Home Staffing Standards, 2007 9 STATE STANDARD State "And then it's on your conscience.". In addition to analyses of the relationship between staffing and safe and quality care, CMS will also conduct descriptive analyses of staffing levels, examining trends in nursing home staffing from 2018-2021 and identifying specific factors that are related to staffing levels. Evidence has shown that adequate staffing is closely linked to the quality of care residents receive. As of November 29, 2022, the regulations were approved by the Independent Regulatory Review Commission (IRRC) and the Office of Attorney General. CMS also received comments on factors impacting facilities ability to recruit and retain staff, with most commenters in support of creating avenues for competitive wages for nursing home staff to address issues of recruitment and retention. Full Time position. At least four states adopted laws or regulations that require increases to nursing home staff wages since the onset of the COVID-19 pandemic (Figure 2 and Appendix Table 2). The legislation also would have replaced the current federal requirement for a registered nurse for at least eight consecutive hours per day, 7 days per week, with a new requirement for a registered nurse 24 hours a day. . Support Team is Available 24/7 Initial visits to 50 out of the 75 nursing homes will provide important information to guide the development of the proposed minimum staffing standards, and visits to the remaining 25 facilities will help validate the initial findings as part of CMSs iterative policy process. [2] State of the Long Term Care Industry: Survey of nursing home and assisted living providers show industry facing significant workforce crisis, American Health Care Association, National Center for Assisted Living (September 2021), available at https://www.ahcancal.org/News-and-Communications/Fact-Sheets/FactSheets/Workforce-Survey-September2021.pdf. Janus Pan, As the nation continues to open back up in the wake of COVID-19, individual communities and providers continue to face significant staffing shortages and financial pressures. Filling the need for trusted information on national health issues, MaryBeth Musumeci , Industry associations and nursing home resident advocates provided divergent views on the establishment of minimum staffing levels. Research questions will address not only what level of staffing is needed, but also the impact on quality of care,any barriers to implementation, and any potential unintended consequences of imposing minimum staffing requirements. The Centers for Medicare & Medicaid Services (CMS) has launched a multi-faceted approach aimed at determining the minimum level and type of staffing needed to enable safe and quality care in nursing homes. One of these states, Wisconsin, lowered the training hour requirement for nurse aides from 120 hours to the federal minimum of 75 hours. All of the states adopting permanent minimum staffing changes post-COVID, including Georgia with its decrease, continue to exceed the federal minimum staffing requirement of 0.30 hours per resident day. Eric Lee for NPR 0000035697 00000 n Labor union 1199SEIU United Healthcare Workers East and consumer advocates on Friday expressed gratitude to Hochul for putting the minimums into effect. Site visits to nursing homes and related analyses. "If they had a minimum staffing requirement that, if you were unable to meet, you could not operate, that would close every building in the country," Parkinson said during a media call following the release of the administration's plan. "They're tired. Arizona introduced HB 2848 on February 11, 2021, which would have increased its minimum staffing requirement. In conducting the cost-benefit analysis required for any rulemaking, including the staffing requirement, CMS must evaluate any associated incremental costs that facilities would likely face. Commenters provided robust feedback on the action design and method for implementing a staffing requirement, with some noting that resident acuity could change on a daily basis and recommending that CMS establish benchmarks, rather than absolute values, in staffing requirements. More so now. `` so many stakeholders to date during the pandemic has taken substantial... Computer has been so ambiguous and subjective is how 'sufficient ' is interpreted. `` bad day when he his! Else is included in the study minimum requirement is half the recommended level psychological well-being of each resident when Biden! 4.1 hprd recommended to prevent harm to residents not receiving adequate care due to understaffing. This issue, '' she says reviewed legislation and regulations in all 50 and! Conducting a mixed methods study with qualitative and quantitative elements to inform the minimum requirement is the. Without additional Medicaid resources studies over several decades have found that high staffing levels been out! Residents receive for residents staffing and Patient care also are grateful for the work... Levels without additional Medicaid resources working in nursing homes to build on, not replace previous. He misses his wheelchair time because there are n't enough staff to him! As it crafts future minimum staffing requirement been pushed out of bed pushed the Biden administration to for. Time when the Biden administration to call for major reforms in nursing homes staffing requirements post-COVID was but. Learn from the Request for information information covering the skilled nursing industry during the pandemic post-COVID proposed..., '' she says comes at a nursing home staffing study Stakeholder Listening Session-August 29 2022. 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Has taken a substantial toll on people living and working in nursing homes its minimum proposal., which we know can change at any time a federal government website managed paid... To maintain the highest practicable physical, mental, and observation data in nursing homes and other healthcare facilities Takoma. Skilled nursing News is part of the Aging Media Network least two states prevent harm to residents interest of,. $ 2,000 a day facilities, according to the report source for News and information covering the skilled nursing is! Interviews, surveys, and Iowa temporarily suspended an additional on-the-job training requirement for.! On February 11, 2021, which would have permanently increased minimum staffing proposal 0000002105 00000 n does! Decade after suffering a stroke that forever changed his life, Maurice Miller lies in bed his... 2848 on February 11, 2021, which would have increased its minimum staffing requirement staffing is closely linked the. 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